The lack of a literature and "office policy" can predispose us to direct those with hypertensive urgency to the hospital.
- The study reassures us that clinical events are extremely rare and that harm, as a result of fruitless testing and hospital admission, is real. I see these individuals in the office within 1 week.
- The researchers postulate that hospital evaluations are not linked to improved outcomes and therefore that office patients sent to the ED would not have fewer CV events than those sent home. The study results show hospital referrals to be (non-significantly) associated with more CV events. It is likely that only the highest risk patients were directed to the ED and hence the greater event rate.
- Criticism: 15% of the cohort was lost to follow-up. Because the number of events was small, capturing even a few additional outcomes could challenge the study's conclusions.
- Disclosures: I have no conflicts to declare.